Dyspnea, edema, and syncope 35 years after “total correction” of tetralogy of Fallot

Aman had had an operation for tetralogy of Fallot at age 5. He was much improved for many years, but when he presented at age 40, he indicated that approximately 4 years earlier he had begun to note exertional dyspnea and ankle edema. Two and a half years earlier, he had had atrial flutter, but since then he had been in sinus rhythm. He had several syncopal episodes, but none in the previous 6 to 12 months.